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A measles outbreak in Washington State prompted Governor Jay Inslee to declare the state of emergency on Jan. 25.
On Thursday, 55 cases had been confirmed this year, most of them in children under 10 who were not vaccinated. The epicenter of the outbreak is Clark County, in the state of Washington, just north of Portland, Oregon.
Measles is a highly contagious disease that can cause brain damage, deafness and, in rare cases, death. In 2000, measles was declared eliminated from the United States through extensive vaccination campaigns.
However, cases have already been reported in 11 states this winter and disease control and prevention centers are currently monitoring three outbreaks (defined as three or more confirmed cases) in New York, New York, and New York. Washington State.
Vaccination rates around 90-95% are usually enough to prevent an epidemic, according to health officials, but rates have declined across the United States.
One of the factors is the spread of misinformation about the measles vaccine, considered safe and effective by the health authorities.
Vaccination rates in the Pacific Northwest are among the lowest in the country. While all schoolchildren must receive MMR vaccine that protects against measles, mumps and rubella, Washington is one of 17 states that allow "philosophical waivers", meaning that a parent can provide child to get vaccinated for almost any reason.
Currently, the vaccination rate in Clark country is 78%, but some schools in the region have rates below 40%, according to the Clark County Health website. Public health officials work around the clock to contain the epidemic.
Ari Shapiro, of NPR, has spoken with Dr. Alan Melnick, Director of Public Health at Clark Country, about the situation. Here are the highlights of the interview, which has been modified to improve the length and clarity.
Are parents responsible for this epidemic?
I do not want to point anyone. I think there is a lot of misinformation on social media and elsewhere that seems quite sophisticated. And I think some parents who are otherwise well-meaning are scared and do not know what to do. Some choose not to vaccinate their children.
But in the end, it was avoidable?
This problem was 100% preventable. What we see here does not need to happen. We should have eradicated measles not only from the United States, but from the world now.
Tell us how bad it is. I know that it is very contagious.
First of all, social media that opposes vaccination is very misinformed about the seriousness of the situation. Measles is not a benign disease. It is a life-threatening disease.
Prior to routine immunization in the United States in the early 1960s, we had between 400 and 500 measles deaths each year. Each year, nearly 50,000 hospitalizations were due to measles and about 4,000 people had measles encephalitis, a swelling of the brain that could lead to permanent injuries, including deafness. It is an extremely serious disease that can lead to many complications. We have already had a child hospitalized on this case.
It is also very contagious. If you are susceptible and have not been vaccinated, you can stay in a room for two hours after the person with measles has left and get it. If a person with measles is present among a group of unvaccinated people, 90% of them will get sick.
The first symptoms of measles are runny nose, cough, fever and red or pink eyes, very common symptoms at this time of year. And these symptoms manifest themselves several days before the onset of the rash. You are extremely contagious at this time and you may not even know that you have measles.
You are also contagious after the onset of the rash. But a few days before the onset of the rash, if you show these symptoms in public, you can spread the disease without knowing it. The only way to know that you can not spread this disease is to get vaccinated in advance.
What happens to children who come back with a positive diagnosis of measles?
Because you are contagious for four days after the onset of rash, the children would be kept at home until then. Four days after the onset of the rash, you are usually not contagious.
When we are able to identify a child who has measles, [from a public health perspective] we want to identify where they have been during their contagion period, because we want to prevent it from spreading. We need to be concerned about exposed people who are not immune.
Your department has published a list of public exhibition venues in Clark County, which includes doctors' offices, schools, daycares, churches, a Joe Trader and a Wal-Mart. Do you mean that unvaccinated people present at these places during a given period could be infected?
Yes. It is one of the most contagious viruses that man knows. It spreads in the air and can linger in an area that lasts up to two hours.
If the exhibition site is in a school, we need to work with it to identify the unvaccinated children and school staff. And we need to exclude them from school for 21 days, that is, the time it would take to develop measles.
We are particularly concerned if it is a doctor's exposure or an emergency department, because the people most at risk of contracting measles are infants too young to be vaccinated, the immunocompromised people that you could meet in an emergency room or doctor's office and pregnant women who have not been vaccinated.
Washington is one of 17 states that allows a philosophical exemption for vaccinations. Do you think it's a mistake?
I am in favor of amending this exemption. In Washington State, there are three ways to exempt your child from school vaccination obligations.
One is a medical exemption that is really rare, there are very few medical contraindications to vaccination.
There is a religious exemption that is also rarely used because there are not many religions that I can think of that say "you will not vaccinate your child".
The vast majority of exemptions are therefore personal or philosophical. California got rid of its personal exemption a few years ago after the Disneyland hatch and I hope the Washington state legislature will do the same.
You can actually check out the Washington State Department of Health website and view our interactive map for vaccination rates in all schools in the state.
The overall average vaccination rate in Clark County, Kindergarten to Grade 12 is about 78%. For herd immunization against measles, it takes about 90 to 95%.
The average of 78% is bad enough, but there are schools in Clark County with vaccination rates much lower than that. It really keeps me awake at night, because if you introduce measles into a population like that, it can spread very quickly.
You have been trained as a family doctor at a time when measles was not considered a threat because people were being vaccinated. What does it look like to see this disease threatening American lives again?
There is no reason for us to ever experience such an epidemic again.
Having a hospitalized child is pretty horrible, but thinking that we could have a death or a serious complication like measles encephalitis is inadmissible.
May I ask you to speak for a moment with parents in the United States who have not vaccinated their children? What is your message to them?
One message is that this disease is horrible. We must protect our children. And … no matter what you hear on some of the social media sites, the vaccine is effective and inexpensive.
outraged [thinking of the safety of] you and your children, we must think about protecting those of us who may not be vaccinated, such as infants who are too young or people with severe immunosuppression.
Immunize your children not only to protect them, but to protect anyone they may come into contact with. Already in Clark County, we had to administer immunoglobulin to a number of infants too young to be vaccinated and who were exposed. We hope that the immunoglobulin works. This is not the first choice, but it is the only thing we have for these infants.
Why do you think the campaign to get people to vaccinate their children has not worked?
I think we have been complacent and that there is a lot of misinformation. … Measles is always present and it is only a journey by plane, bus or car.
Jonathan Lambert is an intern at NPR's Science Desk. You can follow him on Twitter: @evolambert.
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